Transcript of "Breast Pathology Lecture - 2013"

1.
Knowledge is a burden,
If it robs you of innocence,
If it makes you feel you are special,
If it gives you an idea you are wise,
If it is not integrated into life,
If it does not bring you joy,
If it does not set you free.
Sri Sri Ravi Shankar,
Humanitarian and founder of the Art of Living Foundation, India.

5.
CPC 4.5 – 42y Woman, sore R. breast.
2013 Term 4 CPC 5 Title: Breast Cancer
System: Breast
Aim: Clinical, Pathology & population study of patients breast
disease
1. Demonstrate competency in history taking & the
clinical examination of patients with breast
disease.
2. Describe the first line investigation and
management of patients with breast disease or
symptoms.
Learning outcomes
The student will be 3. Describe the Pathophysiology of breast
disease (benign and malignant)
able to
4. Outline the basic sciences relating to function of
the breasts.
5. Describe the Epidemiology and aetiology of breast
disease in Australia and world wide.
6. Illustrate the advantages and disadvantages of
the breast screening program in Australia

44.
Education has two important
characteristics. One is learning of a
subject & skill. The other is the
personality to apply this knowledge to
the benefit of community.
--Baba
One without the other is either useless or dangerous…. !
Knowledge, Skill & Attitude
* JCU graduate attributes..

45.
Breast Carcinoma – Aus. stat.

The most common cancer among Australian women (also
in aboriginals). (20%)
 UK 1 in 10 women, 1 in 8 in US, 1 in 9 Aus.
 One in nine women before the age of 85.
 28% of all cancer diagnoses in 2006.
 Increased from 5,289 in 1982 to 12,614 in 2006
 Commonest cause of death in young < 55y
 Rare before age 30. (30-50 genetic, >50 sporadic)
 Much less incidence in Asia, Japan.
 Majority of cancers arise in the ducts.
 Survival is improving with therapy. (96% 5y – 2006)

82.
HER2 (Human Epidermal growth factor Receptor 2)

The HER2 proto-oncogene encodes a cell surface
receptor that is over expressed in approximately 25%30% of breast cancers. (normally 2 copies).
 HER2 positive breast cancers grow quickly and spread
more than others. (poor prognosis)
 HER2 testing (Immunohistochemistry/FISH) results are
critical to ensuring that patients who may benefit from the
anti-HER2 antibody therapy.
 Trastuzumab (Herceptin®) is the first monoclonal antibody
that targets the extra cellular domain of the HER2
protein, and inhibits growth of breast cancer cells that over
express this protein.

88.
Confusion
Distinction and explanation
Fibroadenoma &
Fibroadenosis
Fibroadenoma is a localized circumscribed benign neoplasm comprising
epithelial cells and specialised fibrous tissue. Fibroadenosis is an obsolete
name for fibrocystic change, a diffuse hyperplastic lesion.
Fibroadenoma &
phyllodes tumour
both comprise neoplastic epithelial and fibrous tissue components. However,
in phyllodes tumours the fibrous tissue component is more cellular and
abundant, and the lesion has less well defined margins; borderline and
malignant variants occur.
Ductal epithelial
hyperplasia &
ductalcarcinoma
in situ
Ductal epithelial hyperplasia is a benign proliferation of duct epithelium,
whereas ductal carcinoma in situ has undergone neoplastic transformation,
although it is not yet invasive. These lesions can have morphological
similarities. A proportion share genetic alterations.
Radial scar &
complex
sclerosing lesion
Radial scars and complex sclerosing lesions differ only in size: the latter are
>10 mm diameter. Both mimic carcinomas radiologically and histologically,
but they are benign non-neoplastic lesions.
Medullary
carcinoma of the
breast & of the
thyroid
The term medullary refers only to the soft consistency (resembling the
medulla of the brain). There is no other relationship between these lesions.
Paget's disease of
the nipple & of
bone
Both lesions were described by Sir James Paget (1814-1899). There is no
other relationship between these lesions.

90.
What is this? 
•
•
•
•
What is PET Scan?
What contrast is used?
What does it show?
What are its Indications ?
•
•
•
•
Positron Emission Tomography.
Radiolabelled glucose by IV.
High metabolic rate cells (cancer cells)
3D view of cancer spread over body.